There’s a lot truth to that, but let’s not go too far off the other end. Sure, I can point to SSRI’s not working by means of increasing the availability of serotonin but of increasing neurogenesis in the hippocampus. But the fact of the matter is that these drugs do work for the vast majority of people who neatly fall into specific Dx categories.
The fact that the precise mechanism by which a drug works may be obscure is largely irrelevant from the clinical point of view. In fact, pick any 10 drugs at random and look them up in the PDR and check the pharmacology section. If it doesn’t flat out say that the mechanism is unknown it will at least come with a bucket full of caveats. This is true even for non-psychotropics although possibly to a lesser degree since for something like a proton pump inhibitor, the cause and effect relationship is more easily investigated.
Someone remind me what this fallacy is called? Or is it just a version of Ad Hominem?
My own view is similar to (but not as well-informed as) AHunter3’s. The dark ages of psychiatry, where non-science and pseudoscience dominated the field, seem to be much more recent than in medicine. I would like to think that further research into psychopharmacology and the explosive increase in understanding I expect to come from neuroscience will bring psychiatric practice fully into the light and somewhat on par with medicine when it comes to diagnosis and treatment.
What I fear is that the fields of psychiatry and psychopharmacology will instead be driven more by market forces than by science, leading to continued or increasingly weakened integrity of those who make a living selling mental health.
I think it’s important to recognize the differences between the OP, which was focused on the validity of disorder categories or diagnoses, and this latter issue, which is about pharmacotherapy. (For some reason, other types of therapy are not included in these recent condemnations, but perhaps that is due to the focus on psychiatry rather than mental health at large?)
There is a lot more to be concerned about when it comes to pharmacotherapy, but there are some very well established medication treatments for specific disorders. For instance, antipsychotic medications have been far more successful in terms of treating schizophrenia than any other treatment strategy. Lithium is superior for bipolar disorder. Stimulant medication treatment is very effective as a treatment for ADHD. SSRIs, in combination with cognitive behavioral therapy is effective for OCD. Evidence for pharmacotherapy for other anxiety disorders is somewhat weaker.
Questions about pharmacotherapy for depression exist. No pharmacotherapy is established for oppositional defiant disorder or conduct disorder.
The “chemical imbalance” model may remain prominent in the public, but are not particularly mentioned otherwise.
However treatment regimes unfortunately are still often discovered mostly by accident or by chemical manipulation of other older psychotropics. Take ketamine for example. This is an anesthetic drug for the most part but it was recently discovered that it could provide nearly instantaneous relief even treatment resistant depression.
In addition (see same link) it appears that ketamine stimulates the release of BDNF which may increase neurogenesis, thus providing a link with the mechanism implicated for some SSRI’s.
Brains, unfortunately, tend to adapt. Throw a bunch of reuptake inhibitors at them and the receptor sites may atrophy or the rate at which the original neurotransmitter is being produced may decline, either of which offsets the pharmaceutical’s actions and, in doing so, creates a drug dependency.
There’s no evidence that people with a psychiatric diagnosis have a different neurochemical nature than control groups of the nondiagnosed “normal” folks.
I’d have to do some research but I think the mere fact that treating someone with say debilitating OCD with say Luvox returns them to being a functional human being tends to indicate that *something *on a neurochemical basis different - don’t you think?
As for feedback loops and up regulation, down regulation and all that goes with it, it’s not at all clear how those mechanisms work at this point. It does seem that over a period of many years that some subset of people will experience some level of adaptation. However if you have bought them a decade or two of relative normalcy as a result of treatment, I’m not sure I see a problem with that.
Coming from left-field as I know very little about the topic under discussion – but would it be possible for you to provide a cite (or three) for the bolded statement? Logically, it does make a lot of sense to me – what’s “normal” anyway? Why not just different from the norm? Especially if they are not harming anyone but themselves? And I mean that in the sense of people that choose suicide over life…might just be the “best” choice available to them. Moreover, it gives them the choice of when to do it and not let it become an anxiety-driven, depression-inducing, random event that inevitably occurs the older you get. That seems ‘sane’ to me.
Start with Whitaker. Consider him a meta-cite as his own claims and data are heavily cited; his book is a summary of research pointing to this conclusion.
So your cite is a popular book by a journalist? No peer-reviewed journal articles, no meta-analysis of studies of drug efficacy? That’s hardly something that can be taken too seriously. Even he happens to rely on reputable sources, you’re relying on him to understand them properly in context of the field of study in which they were published and I’m sorry, I don’t have that sort of faith in anyone.
I have to wonder how much research has been done on people who have successfully turned their lives around and actually became sane after years or decades of being really screwed up. TV preachers, motivational speakers and all types of con artists could proably teach phychiatry a thing or two. I believe in the term’ fake it till you make it’. Proper behavior can elicit positive responses from those around us which will inturn generate some of the right chemicals we need. I would like to see the Dr’s get more into behavioral modification.
The most well established treatments for depression, anxiety and the behavioral disorders are cognitive behavioral therapies. Why would you assume that professionals were ignorant of such things?
Also, people cannot will themselves out of psychopathology, or fake it til they make it.